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Specialist Consultation For A Hospitalized Patient

Massachusetts rates for HCPCS 99253

This covers an initial evaluation of a hospitalized patient by a specialist at the request of another treating doctor, seeking advice or a second opinion on the patient's care. It involves a detailed review of the patient's history and a physical exam, along with medical decision-making of low complexity. The requesting doctor remains involved in the patient's care alongside the consulting specialist.

Rates data updated July 2026.

How much does Specialist Consultation For A Hospitalized Patient cost?

$138

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $138 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $141 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$138$117 to $191
FacilityA hospital or hospital-owned outpatient department$141$117 to $158

How much rates vary

Facilitymedian $141 · 10th to 90th $112 to $166Professionalmedian $138 · 10th to 90th $98 to $282
$100$200$500facility $141professional $138

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$134.90
Typical High
$295.12
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$707.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$190.55
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$173.78
Typical High
$245.47
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$138.04
Typical High
$239.88
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$112.20
Typical High
$162.18
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$257.04
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$275.42

Where Massachusetts sits

The same service costs 2.2 times more in South Dakota than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Massachusetts· 14th of 51

$138

SD $209DC $95.50

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.